After-visit summaries for glaucoma medication vary in efficacy
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Recall of after-visit summaries and correlation with medication adherence varied between patients with glaucoma who did and did not receive a summary, according to a study published in Journal of Glaucoma.
“The [after-visit summary (AVS)] is recommended to be provided to a patient within 3 days of a visit and may include information such as the patient’s diagnosis, medications, medical history and future visits.” Kyle J. Hirabayashi, from the School of Medicine and Health Sciences at George Washington University, Wash, and colleagues wrote. “These measures ultimately aim to improve patients’ understanding of their health conditions and to help patients to be involved in their care between visits.”
The study involved 66 patients who received an AVS at a visit and 52 who did not. Twenty-two patients in the AVS cohort correctly responded to a questionnaire that they had received the summary, while 34 reported they did not, and eight could not remember. In the no-AVS cohort, 30 patients recalled correctly, while eight responded that they received a summary, and 13 could not remember.
Hirabayashi and colleagues assessed medication recall by three points: name or color of bottle or cap, treatment eye(s) and dosing regimen. Fewer patients who received an AVS recorded a “perfect” three-point recall score compared with those who did not (69.7% vs. 80.8%).
Multivariate analysis showed that an associate’s college degree or higher (P = .0002) and lower number of prescribed eye medications (P = .002) independently predicted higher overall recall scores.
The number of ophthalmic medications prescribed to patients who did and did not receive a summary was not significantly different. However, the researchers found a significant association between receiving an AVS and change in ophthalmic medication regimen at prior visit (P < .0001), fewer number of days since last visit (P < .0001) and seeing one of two providers at their visit (P = .0001).
“Further work needs to be done to determine whether modifying the AVS and whether educating patients about the value of the AVS and determining which patients may require longer explanations about their care will have greater and consistent impacts on medication recall and health outcomes,” Hirabayashi and colleagues concluded. “Providing a printed AVS to a patient may not be sufficient, and additional means of communication may be necessary to improve medication recall.” – by Talitha Bennett
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Mark Eltis, OD, FAAO
In an age of extraordinary technological breakthroughs in glaucoma testing and therapy, it is easy to forget that communication remains vitally important. You can prescribe the most effective IOP lowering drops, but if your patient doesn’t know how to use them it’s all rendered meaningless.
There is no “one size fits all” for therapeutics, and the same applies to patient education. Reminders (written or oral) must be tailored to a specific audience. For some patients, an AVS may be helpful, but the delivery method can also be important: printed, SMS, email, phone or apps.
While the effectiveness of AVS remains unclear in this study, telehealth could play a role for patients who prefer oral reminders. There is zero compromise on the quality of care (as there would be for a procedure that would require instrumentation) and it can be extremely convenient for the elderly or those with special needs. Better yet, trained staff can be employed to respond to common questions.
For those who would dismiss such consults as less important than other aspects of glaucoma care, I argue that an ounce of prevention (or patient education) is worth a pound of medical and surgical intervention later.
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